Neumann Matt, Stevens Ryan W, Cole Kristin, Vergidis Paschalis, Virk Abinash, Ilges Dan, Jensen Kelsey L
Department of Pharmacy, Mayo Clinic Health System, Austin, MN, USA.
Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Apr 21;5(1):e96. doi: 10.1017/ash.2025.62. eCollection 2025.
Optimizing antibiotic prescribing for urinary tract infections (UTI) represents an opportunity for ambulatory antibiotic stewardship programs (ASPs). A pre-populated order panel for UTI was implemented in the Mayo Clinic Enterprise in May 2022. The order panel provides antibiotic regimens aligning with institutional guidelines according to patient characteristics, presence or absence of complicating features, and antimicrobial allergy status. We assessed impacts of panel use on prescribing practices for cystitis.
This retrospective cohort study of ambulatory encounters with a primary diagnosis of cystitis from May 16, 2022, to May 15, 2023, compared encounters in which the order panel was utilized to encounters managed without the panel. The primary outcome was concordance with institutional guidelines, including drug selection, dose/frequency, and duration. Secondary outcomes included rate of repeat healthcare contact for UTI within 14 days and total duration of therapy.
793 randomly selected patient encounters (397 panel and 396 non-panel) were included. Prescribing was guideline adherent in 79.3% and 64.9% ( < 0.001) of panel and non-panel encounters, respectively. There were more 3- and 5-day treatment courses in the panel cohort; however, inappropriate duration of therapy was the most common reason for non-concordance in both cohorts. There was no significant difference between groups in repeat 14-day healthcare contact for UTI (13.4% panel vs 11.1% no panel, = 0.34).
Use of a pre-populated ambulatory order panel for the treatment of cystitis was associated with greater concordance with institutional guidelines, without adversely impacting repeat healthcare contact for UTI.
优化尿路感染（UTI）的抗生素处方是门诊抗生素管理计划（ASP）的一个契机。2022年5月，梅奥诊所企业实施了一个预先填写好的UTI医嘱模板。该医嘱模板根据患者特征、是否存在复杂特征以及抗菌药物过敏状态，提供符合机构指南的抗生素治疗方案。我们评估了使用该模板对膀胱炎处方实践的影响。
这项回顾性队列研究纳入了2022年5月16日至2023年5月15日以膀胱炎为主诊断的门诊就诊病例，比较了使用医嘱模板的就诊病例和未使用模板管理的就诊病例。主要结局是与机构指南的一致性，包括药物选择、剂量/频率和疗程。次要结局包括14天内UTI再次就医的发生率和总治疗时长。
纳入了793例随机选择的患者就诊病例（397例使用模板，396例未使用模板）。使用模板和未使用模板的就诊病例中，处方符合指南的比例分别为79.3%和64.9%（<0.001）。使用模板的队列中3天和5天治疗疗程更多；然而，治疗疗程不当是两个队列中不符合指南的最常见原因。两组在UTI 14天内再次就医方面无显著差异（使用模板组为13.4%，未使用模板组为11.1%，P = 0.34）。
使用预先填写好的门诊医嘱模板治疗膀胱炎与更高的机构指南一致性相关，且对UTI再次就医无不利影响。
